Perineal Operations for Rectal Prolapse

Abstract

Rectal prolapse surgery aims at correcting the morphological problem while preserving or improving function. Both perineal and abdominal approaches (see Chap. 71) have their role. Each has its pros and cons and neither allows for an absolute guarantee. Perineal operations for rectal prolapse are the surgery of choice in emergencies, and under elective circumstances, they may be preferable in frail patients who might not tolerate an abdominal procedure and/or deep anesthesia. This chapter describes the surgical strategy and technique for perineal proctosigmoidectomy (Altemeier procedure), mucosal resection with muscular cuff plication (Delorme procedure), and the surgical legacy procedure termed the anal encirclement or Thiersch operation. The indications, contraindications, pitfalls and danger points, postoperative management, and complications are detailed.